pISSN 2093-2340   eISSN 2092-6448
Indexed in ESCI, PubMed, Scopus, DOAJ and more
Open Access, Peer-reviewed
    Infect Chemother. 2012 Aug;44(4):275-281. Korean.
    Published online Aug 31, 2012.
    https://doi.org/10.3947/ic.2012.44.4.275
    Copyright © 2012 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Original Article

    Changes in Antimicrobial Susceptibility of Blood Isolates in a University Hospital in South Korea, 1998-2010

    Nak-Hyun Kim,1 Jeong-Hwan Hwang,1 Kyoung-Ho Song,1 Pyoeng Gyun Choe,1 Wan Beom Park,1 Eu Suk Kim,1 Sang-Won Park,1 Hong Bin Kim,1 Nam Joong Kim,1 Myoung-don Oh,1 and Eui-Chong Kim2
      • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
      • 2Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
    • Correspondence to Eui-Chong Kim, M.D. Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-3500, Fax: +82-2-747-0359, Email: euichong@snu.ac.kr
    Received February 21, 2012; Revised May 22, 2012; Accepted May 22, 2012.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Background

    Local epidemiologic data on prevalent pathogens are important to guide empirical antibiotic therapy. In this study, we observed annual changes in frequency of occurrence and in vitro antimicrobial susceptibility of blood isolates over a period of 13 years.

    Materials and Methods

    We reviewed blood isolates identified during the period from 1998 to 2010 at Seoul National University Hospital. Only first isolates for each patient were included in the analysis. We analyzed the frequency of isolates and their trend with regard to in vitro antimicrobial susceptibility. Data were presented according to guidelines of the Clinical and Laboratory Standards Institute (CLSI) (2009).

    Results

    A total of 23,501 isolates were identified during the period from 1998 to 2010. Fifty-five percent of the isolates were gram-positive cocci, 38% were gram-negative rods, and 3% were fungi. Coagulase-negative Staphylococcus (CoNS) (24%), Escherichia coli (16%), Staphylococcus aureus (10%), and Klebsiella pneumoniae (8%) were the most commonly isolated bacteria, and Candida albicans (2%) was the most commonly isolated fungus. The frequency of CoNS increased from 18.0% to 26.8%, whereas the frequency of E. coli and K. pneumoniae decreased from 20.2% to 13.7% and from 11.7% to 6.7%, respectively. Overall, the proportion of methicillin-resistant S. aureus changed from 47.9% to 62.1%. In E. coli, the resistance rate of cefotaxime and ciprofloxacin increased over a period of 13 years. However, such an increase of resistance was not observed in K. pneumoniae. In P. aeruginosa, and particularly in A. baumannii, resistance to imipenem rose alarmingly (3% in 1998 to 27.8% in 2010, 5% in 1998 to 68.9% in 2010, respectively).

    Conclusions

    Over the last 13 years, the proportion of CoNS in blood isolates increased, which led to a relative decrease of isolated gram-negative rods. Proportions of MRSA showed no significant change, whereas cefotaxime resistant and ciprofloxacin resistant E. coli increased. Imipenem resistant P. aeruginosa and A. baumannii also increased during the study period.

    Keywords
    Blood culture; Bacteremia; Antimicrobial susceptibility trends

    Figures

    Figure 1
    Proportions of blood culture isolates during 1998-2010.

    Figure 2
    13-year trend of S. aureus for % resistant to ciprofloxacin, oxacillin, rifampin, cotrimoxazole, vancomycin. CIP, ciprofloxacin; OXA, oxacillin; RIF, rifampin; SXT, cotrimoxazole; VAN, vancomycin; %R, %resistant.

    Figure 3
    13-year trend of E. faecium and E. faecalis for % resistant to ampicillin and vancomycin. EFA, E. faecalis ; EFM, E. faecium; AMP, ampicillin; VAN, vancomycin; %R, %resistant.

    Figure 4
    13-year trend of E. coli and K. pneumoniae for % resistant to ceftriaxone and ciprofloxacin. ECO, E. coli; KPN, K. pneumoniae; CTX, cefotaxime; CIP, ciprofloxacin; %R, %resistant.

    Figure 5
    13-year trend of P. aeruginosa and A.baumannii for % resistant to imipenem, colistin, and ciprofloxacin. PAE, P. aeruginosa; ABA, A. baumannii; IMP, imipenem; COL, colistin; CIP, ciprofloxacin; %R, %resistant.

    Tables

    Table 1
    Frequency of Blood Isolates

    Table 2
    The 15 Organisms Isolated Most Frequently from Blood Cultures

    References

      1. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584–602.
      1. Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998;244:379–386.
      1. Kang CI, Kim SH, Kim HB, Park SW, Choe YJ, Oh MD, Kim EC, Choe KW. Pseudomonas aeruginosa bacteremia: risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis 2003;37:745–751.
      1. Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997-2002). Diagn Microbiol Infect Dis 2004;50:59–69.
      1. Decousser JW, Lamy B, Pina P, Allouch PY. Collège de Bactériologie Virologie Hygiène Study Group (ColBVH). Trends in antibiotic susceptibility of bloodstream pathogens in hospitalized patients in France, 1996 to 2007. Diagn Microbiol Infect Dis 2010;66:292–300.
      1. Raveh D, Rudensky B, Schlesinger Y, Benenson S, Yinnon AM. Susceptibility trends in bacteraemias: analyses of 7544 patient-unique bacteraemic episodes spanning 11 years (1990-2000). J Hosp Infect 2003;55:196–203.
      1. Fluit AC, Jones ME, Schmitz FJ, Acar J, Gupta R, Verhoef J. Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the SENTRY antimicrobial surveillance program, 1997 and 1998. Clin Infect Dis 2000;30:454–460.
      1. Streit JM, Jones RN, Sader HS, Fritsche TR. Assessment of pathogen occurrences and resistance profiles among infected patients in the intensive care unit: report from the SENTRY Antimicrobial Surveillance Program (North America, 2001). Int J Antimicrob Agents 2004;24:111–118.
      1. Asensio A, Alvarez-Espejo T, Fernandez-Crehuet J, Ramos A, Vaque-Rafart J, Bishopberger C, Hernandez Navarrete M, Calbo-Torrecillas F, Campayo J, Canton R. Estudio de Prevalencia de las Infecciones Nosocomiales en Espana (EPINE) Working Group. Trends in yearly prevalence of third-generation cephalosporin and fluoroquinolone resistant Enterobacteriaceae infections and antimicrobial use in Spanish hospitals, Spain, 1999 to 2010. Euro Surveill 2011;16:19983.
      1. Ahn GY, Jang Sj, Lee SH, Jeong OY, Chaulagain BP, Moon DS, Park YJ. Trends of the species and antimicrobial susceptibility of microorganisms isolated from blood cultures of patients. Korean J Clin Microbiol 2006;9:42–50.
      1. Kang BK, Lee HJ, Suh JT. The trends of the species and antimicrobial susceptibility of bacteria and fungi isolated from blood cultures (1986-1996). Korean J Clin Pathol 1998;18:57–64.
      1. Kim HJ, Lee NY, Kim S, Shin JH, Kim MN, Kim EC, Koo SH, Ryoo NH, Kim JS, Cho JH. Characteristics of microorganisms isolated from blood cultures at nine university hospitals in Korea during 2009. Korean J Clin Microbiol 2011;14:48–54.
      1. Kim SY, Lim G, Kim MJ, Suh JT, Lee HJ. Trends in five-year blood cultures of patients at a university hospital (2003~2007). Korean J Clin Microbiol 2009;12:163–168.
      1. Koh EM, Lee SG, Kim CK, Kim M, Yong D, Lee K, Kim JM, Kim DS, Chong Y. Microorganisms isolated from blood cultures and their antimicrobial susceptibility patterns at a university hospital during 1994-2003. Korean J Lab Med 2007;27:265–275.
      1. Park Y, Lee Y, Kim M, Choi JY, Yong D, Jeong SH, Kim JM, Lee K, Chong Y. Recent trends of anaerobic bacteria isolated from clinical specimens and clinical characteristics of anaerobic bacteremia. Infect Chemother 2009;41:216–223.
      1. Kang CI, Kim DM, Yi JY, Park WB, Lee KD, Kim HB, Oh MD, Kim EC, Choe KW. Antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae blood isolates over 5 years: Influence of extended-spectrum beta-lactamase-producing organisms. Infect Chemother 2003;35:365–369.
      1. CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement M100-S21. 31. 2011.
      1. CLSI. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data; Approved Guideline - Third Edition. M39-A3. 29. 2009.
      1. Arpi M, Victor MA, Møller JK, Jønsson V, Hansen MM, Peterslund NA, Bruun B. Changing etiology of bacteremia in patients with hematological malignancies in Denmark. Scand J Infect Dis 1994;26:157–162.
      1. Falagas ME, Kasiakou SK, Nikita D, Morfou P, Georgoulias G, Rafailidis PI. Secular trends of antimicrobial resistance of blood isolates in a newly founded Greek hospital. BMC Infect Dis 2006;6:99.
      1. Worth LJ, Slavin MA. Bloodstream infections in haematology: risks and new challenges for prevention. Blood Rev 2009;23:113–122.
      1. Weinstein MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol 2003;41:2275–2278.
      1. Mirrett S, Weinstein MP, Reimer LG, Wilson ML, Reller LB. Relevance of the number of positive bottles in determining clinical significance of coagulase-negative staphylococci in blood cultures. J Clin Microbiol 2001;39:3279–3281.
      1. Weinstein MP, Mirrett S, Van Pelt L, McKinnon M, Zimmer BL, Kloos W, Reller LB. Clinical importance of identifying coagulase-negative staphylococci isolated from blood cultures: evaluation of MicroScan Rapid and Dried Overnight Gram-Positive panels versus a conventional reference method. J Clin Microbiol 1998;36:2089–2092.
      1. Favre B, Hugonnet S, Correa L, Sax H, Rohner P, Pittet D. Nosocomial bacteremia: clinical significance of a single blood culture positive for coagulase-negative staphylococci. Infect Control Hosp Epidemiol 2005;26:697–702.
      1. Chung G, Cha J, Han S, Jang H, Lee K, Yoo J, Yoo J, Kim H, Eun S, Kim B, Park O, Lee Y. Nationwide surveillance study of vancomycin intermediate Staphylococcus aureus strains in Korean hospitals from 2001 to 2006. J Microbiol Biotechnol 2010;20:637–642.
      1. Kim MN. Multidrug-resistant Organisms and Healthcare-associated Infections. Hanyang Med Rev 2011;31:141–152.
      1. Karlowsky JA, Jones ME, Thornsberry C, Friedland IR, Sahm DF. Trends in antimicrobial susceptibilities among Enterobacteriaceae isolated from hospitalized patients in the United States from 1998 to 2001. Antimicrob Agents Chemother 2003;47:1672–1680.
      1. Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010;362:1804–1813.
      1. Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9:228–236.
      1. Lee JY, Song JH, Ko KS. Identification of nonclonal Pseudomonas aeruginosa isolates with reduced colistin susceptibility in Korea. Microb Drug Resist 2011;17:299–304.
    Cited by
    Crossref 13
    Google Scholar 
    MeSH Terms
    Bacteremia
    Bacteria
    Candida albicans
    Cefotaxime
    Ciprofloxacin
    Escherichia coli
    Fungi
    Gram-Positive Cocci
    Humans
    Imipenem
    Klebsiella pneumoniae
    Methicillin Resistance
    Methicillin-Resistant Staphylococcus aureus
    Pneumonia
    Republic of Korea
    Staphylococcus
    Staphylococcus aureus
    Metrics
    Share
    Figures
    slide
    slide
    slide
    slide
    slide

    1 / 5

    Tables
    slide
    slide

    1 / 2

    PERMALINK